{"id":1495,"date":"2015-03-18T22:36:32","date_gmt":"2015-03-18T22:36:32","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=1495"},"modified":"2021-06-09T15:13:15","modified_gmt":"2021-06-09T15:13:15","slug":"4-4-suture-care-and-removal","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/4-4-suture-care-and-removal\/","title":{"raw":"4.5 Staple Removal","rendered":"4.5 Staple Removal"},"content":{"raw":"Staples are made of stainless steel wire and provide strength for wound closure.\u00a0The wound location sometimes restricts their use because the staples must be far enough away from organs and structures. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove.\r\n\r\nRemoval of staples requires sterile technique and a staple extractor.\u00a0An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. The health care professional performing the removal must also inspect the wound prior to the procedure to ensure the wound is adequately healed to have the staples removed.\u00a0Usually\u00a0every second staple is removed initially; then the remainder are removed at a later time (Perry et al., 2014). In general, staples are removed within 7 to 14 days.\r\n\r\nChecklist 36 outlines the steps for removing staples from a wound.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 36: Staple Removal<\/caption>\r\n
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Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
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Safety considerations:\u00a0<\/span><\/h5>\r\n
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Steps<\/h4>\r\n<\/td>\r\n

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\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Confirm physician orders, and explain procedure to patient.<\/td>\r\nExplanation helps prevent anxiety and increases compliance with the procedure. Inform patient the procedure is not painful but the patent may feel some pulling or pinching of the skin during staple removal.<\/td>\r\n<\/tr>\r\n
2. Gather appropriate supplies.<\/td>\r\nGather sterile staple extractors, sterile dressing tray, non-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing.<\/td>\r\n<\/tr>\r\n
3. Position patient appropriately and create privacy for procedure.<\/td>\r\nEnsure proper body mechanics for yourself and create a comfortable position for the patient.<\/td>\r\n<\/tr>\r\n
4. Perform hand hygiene<\/a>.<\/td>\r\nThis reduces the risk of infection.\r\n\r\n[caption id=\"attachment_6220\" align=\"aligncenter\" width=\"150\"]\"Perform<\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n
5. Prepare the sterile field and add necessary supplies (staple extractor).<\/td>\r\nThis step allows easy access to required supplies for the procedure.\r\n\r\n[caption id=\"attachment_5864\" align=\"aligncenter\" width=\"150\"]\"Add<\/a> Add sterile items to sterile field[\/caption]<\/td>\r\n<\/tr>\r\n
6. Remove dressing and inspect the wound.<\/td>\r\nVisually assess the wound for uniform closure of the edges, absence of drainage, redness, and inflammation.\r\n\r\n[caption id=\"attachment_5881\" align=\"aligncenter\" width=\"150\"]\"Remove<\/a> Remove dressing and inspect the wound[\/caption]\r\n\r\nAfter assessing the wound, determine if the wound is sufficiently healed to have the staples removed. If concerns are present, question the order and seek advice from the appropriate health care provider.<\/td>\r\n<\/tr>\r\n
7. Apply non-sterile gloves.<\/td>\r\nThis reduces the risk of contamination.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n
8. Clean incision site according to agency policy.<\/td>\r\nThis reduces the risk of infection from microorganisms on the wound site or surrounding skin.\r\n\r\n[caption id=\"attachment_5886\" align=\"aligncenter\" width=\"150\"]\"Clean<\/a> Clean incision site[\/caption]\r\n\r\nCleaning also loosens and removes any dried blood or crusted exudate from the staples and wound bed.<\/td>\r\n<\/tr>\r\n
\u00a0To Remove Staples (start with every second staple).<\/strong><\/td>\r\n<\/tr>\r\n
9. Place lower tip of staple extractor beneath the staple. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. Close the handle, then gently move the staple side to side to remove.<\/td>\r\nThe closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin.\r\n\r\n[caption id=\"attachment_3952\" align=\"aligncenter\" width=\"150\"]\"Close<\/a> Close the handle, then gently move the staple from side to side to remove[\/caption]<\/td>\r\n<\/tr>\r\n
10. When both ends of the staple are visible, move the staple extractor away from the skin and place the staple on a sterile piece of gauze by releasing the handles on the staple extractor.<\/td>\r\nThis avoids pulling the staple out prematurely and avoids putting pressure on the wound. It also prevents scratching the skin with the sharp staple.\r\n\r\n[caption id=\"attachment_3953\" align=\"aligncenter\" width=\"150\"]\"Keep<\/a> Keep the handle closed and move the staple extractor away from the skin[\/caption]<\/td>\r\n<\/tr>\r\n
11. Continue to remove every second staple to the end of the incision line.<\/td>\r\nAlternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line.\r\n\r\n[caption id=\"attachment_3954\" align=\"aligncenter\" width=\"150\"]\"Continue<\/a> Continue to remove every second staple to the end of the incision line[\/caption]<\/td>\r\n<\/tr>\r\n
12.\u00a0Using the principles of sterile technique,\u00a0place Steri-Strips on location of every removed staple along incision line.<\/td>\r\nCut Steri-Strips to allow them to extend 1.5 to 2 cm on each side of incision.\r\n\r\nRemove sterile backing to apply Steri-Strips.\r\n\r\n[caption id=\"attachment_5933\" align=\"aligncenter\" width=\"150\"]\"Cut<\/a> Cut Steri-Strips[\/caption]\r\n\r\nSteri-Strips support wound tension across wound and eliminate scarring.\u00a0<\/span>\r\n\r\nThis allows wound to heal by primary intention.\r\n\r\n[caption id=\"attachment_3957\" align=\"aligncenter\" width=\"150\"]\"Cut<\/a> Cut Steri-Strips to allow them to extend 1.5 to 2 cm on each side of incision[\/caption]<\/td>\r\n<\/tr>\r\n
13. Remove remaining staples, followed by applying Steri-Strips along the incision line.<\/td>\r\nSteri-Strips support wound tension across wound and eliminate scarring.<\/td>\r\n<\/tr>\r\n
14. Apply dry, sterile dressing on incision site or leave exposed to air if wound is not irritated by clothing, or according to physician orders.<\/td>\r\nThis reduces risk of infection.\r\n\r\n[caption id=\"attachment_4743\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply dry, sterile dressing if required[\/caption]<\/td>\r\n<\/tr>\r\n
15. Position patient, lower bed to safe height, and\u00a0ensure patient is comfortable and free from pain.<\/td>\r\nThis provides patient with a safe, comfortable place, and attends to pain needs as required.<\/td>\r\n<\/tr>\r\n
16. Complete patient teaching regarding Steri-Strips and bathing, wound inspection for separation of wound edges, and ways to enhance wound healing.<\/td>\r\nInstruct patient to take showers rather than bathe.\r\n\r\nInstruct patient not to pull off Steri-Strips and to allow them to fall off naturally and gradually (usually takes one to three\u00a0weeks).\r\n\r\nInstruct on the importance of not straining during defecation, and of adequate rest, fluids, nutrition, and ambulation for optional wound healing.<\/td>\r\n<\/tr>\r\n
17. Discard supplies according to agency policies for sharp disposal and biohazard waste.<\/td>\r\nStaple extractor may be disposed of or sent for sterilization.<\/td>\r\n<\/tr>\r\n
18. Perform hand hygiene<\/a> and document procedure and findings according to agency policy. Report any unusual findings or concerns to the appropriate health care professional.<\/td>\r\nHand hygiene reduces the risk of infection.\r\n\r\n[caption id=\"attachment_5575\" align=\"aligncenter\" width=\"150\"]\"Hand<\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n
Data source: BCIT, 2010c;\u00a0Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

<\/a>Video 4.4<\/h3>\r\n
Watch the video Staple Removal<\/em><\/a>\u00a0by Ren\u00e9e Anderson and Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\n
Special Considerations:<\/h5>\r\n